Dr. Anupama Vyas - Children’s Eye Care and Adult Squint Clinic

Pediatric Glaucoma

Glaucoma is caused by higher-than-normal pressure inside the eyeball, which damages the optic nerve and retina, resulting in gradual loss of vision. In infants and children, this can also cause eye enlargement, clouding of the front surface of the eye, and lazy vision (amblyopia). Pediatric glaucoma can be treated with a combination of eye medicines and eye surgery designed to lower the pressure by allowing more eye fluid to escape (“opening the drain”) or by allowing less eye fluid to be created (“closing the faucet”). Your child may need frequent visits to measure eye pressure or to treat lazy vision with eyeglasses and eye patching

Pediatric Glaucoma Eye Surgery

Dr.Anupama Vyas will carefully consider whether your child will benefit most from glaucoma surgery or further treatment with medications. Eyeglasses or eye patching may be used in cases accompanied by lazy vision.

It's important for treatment of childhood glaucoma to start as early as possible. Treatment may include:

Medications - Some medications cause the eye to produce less fluid, while others lower pressure by helping fluid drain from the eye.

Conventional surgery - The purpose of conventional surgery is to create a new opening for fluid to leave the eye.

Trabeculotomy and Goniotomy : A surgical opening is made into the drainage area of the eye (known as the trabecular meshwork drainage system), therefore establishing a more normal anterior chamber angle that allows the fluid to drain more freely, lowering the intraocular pressure (IOP). A goniotomy is an internal trabeculotomy procedure that is used in congenital glaucoma.

Laser surgery - There are several types of laser surgery used to treat glaucoma, including the following:

Trabeculectomy : A surgical procedure that involves the removal of part of the trabecular meshwork drainage system, allowing the fluid to drain from the eye.

Iidotomy: For this procedure, the surgeon uses the laser to make a small hole in the iris (the colored part of the eye) to allow fluid to flow more freely in the eye.

o Cyclophotocoagulation: This procedure uses a laser beam to freeze selected areas of the ciliary body (the part of the eye that produces aqueous humor) to reduce the production of fluid. This type of surgery may be performed with severe cases of childhood glaucoma.

Both medications and surgery have been successfully used to treat childhood glaucoma.

Problems Related to Glaucoma

Pediatric glaucoma is more difficult to treat than glaucoma in adults. Re-operations on children with glaucoma are the rule rather than the exception. Some children require only one or two surgeries, but in severe cases, 10 or more operations may need to be performed, spaced months to years apart.

Lazy vision (amblyopia) occurs in up to 90% of infants and children with glaucoma, and will need to be treated with glasses (or contact lenses) and eye patching. Amblyopia is usually caused by clouding of the front of the eye or unequal focusing.

Eye crossing (strabismus) and eye wiggling (nystagmus) occur in up to 50% of children with glaucoma. These can often be corrected or significantly improved with eye muscle surgery.

Clouding of the eye lens (cataract) occurs in 20% of children with glaucoma. If the cataract becomes dense, cataract surgery will need to be performed and contact lenses or glasses worn. About 5% of children with glaucoma will also require a corneal transplant, due to clouding of the front clear covering of the eye.